环孢素A治疗难治性肾病综合征

Cyclosporine A in the treatment of steroid resistant and steroid dependent nephrotic syndrome

目的研究环孢素Ａ（ＣｓＡ）治疗难治性肾病综合征的临床疗效并探讨其机制。方法对３０例肾上腺皮质激素依赖或抵抗的肾病综合征（ＮＳ）患者联合使用了（ＣｓＡ，５ｍｇ·ｋｇ－１·ｄ－１）和泼尼松（３０ｍｇ／ｄ）治疗，并测定了ＣｓＡ治疗前后病人的血生化指标、免疫指标及２４小时尿蛋白排出量。结果２４小时尿蛋白排出量由治疗前的平均７．６７±３．００ｇ／２４ｈ降至治疗后第１、２、３个月的４．９３±３．６４ｇ／２４ｈ、３．５２±２．９４ｇ／２４ｈ、２．２３±１．６０ｇ／２４ｈ；血浆白蛋白由治疗前２７．３±６．４ｇ／Ｌ升至３０．９±８．８ｇ／Ｌ、３４．３±７．６ｇ／Ｌ、３６．０±７．２ｇ／Ｌ；治疗前后血肌酐、ＢＵＮ、尿酸、ＣＤ４／ＣＤ８和可溶性白细胞介素２（ＩＬ２）受体无明显变化，而治疗２个月后外周血单个核细胞产生血清ＩＬ２显著下降。治疗后激素抵抗组ＮＳ完全缓解、部分缓解和无效分别为２２．７％，５０．０％和２７．３％；在激素依赖组分别为５７．１％，４２９％和０。有５例患者因肝肾功能损害或严重腹泻而停用ＣｓＡ。结论本研究提示ＣｓＡ联合小剂量皮质激素治疗难治性肾病综合征，尤其是激素依赖的患者是安全和有效的。

Objective To study the effects of cyclosporine A (CsA) in the treatment of refractory nephrotic syndrome (NS). Methods 30 cases of steroid resistant or steroid dependent NS received CsA (5 mg·kg -1 ·d -1 ) together with prednisone (30 mg/d) for at least 3 months. Results 24 hour urine protein excretion was decrease from 7.67±3.00 g/L to 4.93±3.64 g/L ( P <0.01), 3.52±2.94 g/L ( P <0.01), and 2.23±1.60 ( P <0.01) respectively. Serum albumin was increased from 27.3± 6.4 g/L to 30.9±8.8 g/L ( P <0.05) after one month; 34.3±7.6 g/L after two months and 36.0±7.2 g/L after three months respectively. Scr, BUN, UA, CD 4/CD 8, sIL 2R had no significant differences before and after the administration of CsA for one, two and three months. IL 2 produced by PBMC was significantly decreased after two and three months of CsA administration ( P <0.05, P <0.05). Five patients stopped CsA due to deterioration of renal or hepatic function and serious diarrhea. Conclusion CsA (5 mg·kg -1 ·d -1 ) combined with prednisone (30 mg/d) is effective and safe in the treatment of refractory NS patients.